Genital Tract Infections

GENITAL TRACT INFECTION
CMT05104
Learning tasks
• At the end of this session, students are
expected to;
i. Mention common organisms which cause genital
tract infections in women
ii. Describe clinical features of genital tract infections
iii. Describe management of genital tract infections
iv. Describe complications of genital tract infections
v. Describe significance of genital tract infections in
pregnancy.
Introduction
• The common organisms which cause genital
tract infections in women include;
o Candida species
o Trichomonas vaginalis
o Chlamydia species
o Neisseria gonorrhoea
o Treponema pallidum
o Herpes virus
Vulvovaginal Candidiasis(1)
• Caused by C. albicans but occasionally is
caused by other Candida sp. or yeasts.
• Typical symptoms of VVC include
 Pruritus,
Vaginal soreness and/or redness
Dyspareunia,
External dysuria
Abnormal vaginal discharge (Curdlike)
None of these symptoms is specific for VVC
4
• Risk factors
– Use of antibiotics
– Increased estrogen levels
• Pregnant women
• Estrogen birth control pills
• Estrogen hormone therapy
– Uncontrolled diabetes
– Impaired immune system
5
• Diagnosis
– Is established mainly on clinical presentation.
– High Vaginal Swab (HVS) for wet preparations
• Laboratory
– A wet preparation (saline, 10% KOH) or Gram stain of
vaginal discharge demonstrates yeasts or pseudohyphae
– A culture or other test yields a positive result for a yeast
species.
– Candida vaginitis is associated with a normal vaginal pH
(<4.5)
6
• Treatment
– Clotrimazole pessaries 100mg OD for 6 days
– Miconazole pessaries
– Nystatin pessaries
• Complications
– Recurrence
Bacterial Vaginosis (1)
• BV is a polymicrobial clinical syndrome
resulting from replacement of the normal
H2O2 producing Lactobacillus sp. in the vagina
with high concentrations of anaerobic bacteria
(e.g., Prevotella sp. and Mobiluncus sp.), G.
vaginalis, and Mycoplasma hominis.
• Gardnerella vaginalis is however the most
common cause of BV.
8
• BV is the most prevalent cause of vaginal

discharge or malodor; however, more than 50% of
women with BV are asymptomatic
• Clinical criteria require three of the following
symptoms or signs:
 A fishy odor of vaginal discharge before or after addition
of 10% KOH (i.e., the whiff test).
 Homogeneous, thin, grey discharge that smoothly coats
the vaginal walls;
 Presence of clue cells on microscopic examination;
 pH of vaginal fluid >4.5; 9
• Associated with adverse pregnancy outcomes, including
 premature rupture of the membranes,
preterm labor,
 preterm birth,
 intraamniotic infection
 postpartum endometritis.
• Treatment
– Metronidazole 400mg PO BD for 7 days
– Do not give metronidazole in 1sr trimester, use Cefixime
400mg STAT or Azithromycin 1mg STAT
10
Trichomoniasis(1)
• Introduction
– Is a sexually transmitted disease caused by motile
parasitic protozoan Trichomonas vaginalis.
– About 5% of pregnant women carry the infection
• Clinical features
– Profuse, extremely frothy, yellow or greenish
vaginal discharge.
– Itching and irritation extending to the thighs
Trichomoniasis(2)
• Diagnosis
– Wet mount discharge; presence of flagellsted
pyriform protozoa or trichomonads
– Very low sensitivity (25%) and the absence of
trichomonads does not rule out infection.
• Treatment
– Metronidazole 2g PO STAT
– Tinidazole 3g PO STAT in resistance cases
– Both drugs should be used with caution in pregnacy.
Chlamydial infection(1)
• Introduction
– It is caused by chlamydia trachomatis
– Is one of the commonest STIs
– Most infections are asymptomatic (70-80%)
– Vaginal yellow discharge
– Inflammation
• Diagnosis
– Established by clinical features
– DNA PCR testing is highly sensitive and specific, but can only
be done in advanced laboratories.
• Treatment
– Cefixime 400mg PO STAT or
– Azithromycin 1gm PO STAT or
– Erythromycin 500 6hrly PO for 7days
• Complications
– May lead to chronic pelvic pain, ectopic pregnancy
and infertility.
– In pregnancy:
• premature rapture of membranes
• postpartum endometriosis
• opthalmia neonatorum
• neonatal pneumonia
Gonorrhea (1)
• Introduction
– Is a purulent infection of the mucosal membrane surfaces caused
by Neisseria gonorrhoeae.
– Is sexually transmitted disease.
– it is asymptomatic in about 50% of women
– Vaginal discharge
– Dysuria
– Intermenstral bleeding
– Dyspareunia
– Mid lower abdominal pain
– May progress to PID
Gonorrhea (2)
• Diagnosis
– Culture of a swab from the site of infection
• Treatment
– Cefixime 400mg PO STAT or
– Azithromycin 1gm PO STAT or
– Erythromycin 500 6hrly PO for 7days
Gonorrhea (3)
• Complications
– In women can cause chronic pelvic pain, ectopic
pregnancy and infertility.
– In pregnant women
• Abortions, Low birth weight, Premature rapture of
membranes , Preterm labour, Chorioamnionitis
• Postparturm endomyometritis, Pelvic abscess
• Opthalmia neonatorum
Herpes genitalis(1)
• Introduction
– Infection with genital herpes simplex virus(HSV)
remain a common sexually transmitted disease.
– Mainly caused by Herpes simplex type 2 virus
Gonorrhea (2)
– Burning sensation followed by appearance of blisters
– Once blisters rapture leave behind painful ulcers.
– Dysuria
– Dyspareunia
Herpes genitalis(2)
• Complications
– Infections on the new born via vaginal delivary
• Blindness
• Brain damage
• Skin lesions
– Ceasarean delivery is recommended for women
with Herpes
• Treatment
– Acyclovir 400mg TID for 7-10 days or
– Flamciclovir 250mg TID for 7-10 days
Homework
• Read on syphilis in pregnancy
– Causative agent
– Clinical features according to stages
– Management
– Complications in pregnancy
Key points
• Genital tract infections are common and if left
untreated may have impacts to the baby during
pregnancy and after birth.
• Treatment of genital tract infections is
incomplete if the sexual partner is not treated.
• In places with limited resources for investigations
treatment is by syndromic approach
• A clinician needs to be careful when treating
genital tract infections in pregnancy.

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GENITAL TRACT INFECTION

• BV is the most prevalent cause of vaginal

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